Stanford University

Health and Medicine

FSI’s researchers assess health and medicine through the lenses of economics, nutrition and politics. They’re studying and influencing public health policies of local and national governments and the roles that corporations and nongovernmental organizations play in providing health care around the world. Scholars look at how governance affects citizens’ health, how children’s health care access affects the aging process and how to improve children’s health in Guatemala and rural China. They want to know what it will take for people to cook more safely and breathe more easily in developing countries.

FSI professors investigate how lifestyles affect health. What good does gardening do for older Americans? What are the benefits of eating organic food or growing genetically modified rice in China? They study cost-effectiveness by examining programs like those aimed at preventing the spread of tuberculosis in Russian prisons. Policies that impact obesity and undernutrition are examined; as are the public health implications of limiting salt in processed foods and the role of smoking among men who work in Chinese factories. FSI health research looks at sweeping domestic policies like the Affordable Care Act and the role of foreign aid in affecting the price of HIV drugs in Africa.

Contracting with Private Providers for Primary Care Services: Evidence from Urban China

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Controversy surrounds the role of the private sector in health service delivery, including primary care and population health services. China’s recent health reforms call for non-discrimination against private providers and emphasize strengthening primary care, but formal contracting-out initiatives remain few, and the associated empirical evidence is very limited. This paper presents a case study of contracting with private providers for urban primary and preventive health services in Shandong Province, China. The case study draws on three primary sources of data: administrative records; a household survey of over 1600 community residents in Weifang and City Y; and a provider survey of over 1000 staff at community health stations (CHS) in both Weifang and City Y. We supplement the quantitative data with one-on-one, in-depth interviews with key informants, including local officials in charge of public health and government finance.

We find significant differences in patient mix: Residents in the communities served by private community health stations are of lower socioeconomic status (more likely to be uninsured and to report poor health), compared to residents in communities served by a government-owned CHS. Analysis of a household survey of 1013 residents shows that they are more willing to do a routine health exam at their neighborhood CHS if they are of low socioeconomic status (as measured either by education or income). Government and private community health stations in Weifang did not statistically differ in their performance on contracted dimensions, after controlling for size and other CHS characteristics. In contrast, the comparison City Y had lower performance and a large gap between public and private providers. We discuss why these patterns arose and what policymakers and residents considered to be the main issues and concerns regarding primary care services.

Keywords:

Private providers; Contracting; Ownership; Primary care; Prevention; China

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Health Economics Review
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Yan Wang (former)
Karen Eggleston
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The Effects of Economic Transition on Mortality in Shanghai, China

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Much research has linked an increase in adult mortality with the socioeconomic transition of former European socialist societies after 1989. Few studies examine corresponding experiences in China, however. Using the death certificates of Shanghai residents, we examined any such sudden mortality change and crisis when China went through economic transformation. We explored trends in life expectancy at birth and age-specific mortality in Shanghai. We applied Arriaga’s decomposition method to analyze the contributions of specific ages and the causes to the changes in life expectancy. We used harmonic regression models to assess the statistical significance of rising and falling mortality over time. The analysis shows that, coinciding with the economic transition of 1992–1996, the previously steady improvement of life expectancy in Shanghai slowed down. Mortality among working-age males (20–44 years old) increased (P<.001) in Shanghai, largely due to rising cardiovascular disease (CVD) (P<.05) and injury (P<.001). Suicide and liver disease remained stable or fell, while transportation deaths increased in Shanghai. The economic reform in Shanghai seems to include the privatization of state-owned enterprises, economic growth, and initial increases in working-age male mortality in the 1990s.

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Working Papers
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Asia Health Policy Program working paper # 33
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The United Nations and a World in Transition

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United Nations Secretary-General Ban Ki-moon presented a free public talk at Stanford on Thursday, Jan. 17.

Ban, who is the eighth secretary-general of the UN, will speak about the UN's role in creating opportunities out of the challenges posed by today's rapidly transitioning world.

"Times of transition are times of profound opportunity," he recently said during his acceptance speech for the Seoul Peace Prize. "The decisions we make in this period will have an impact for generations to come.”

Ban's initiatives as UN secretary-general have focused on promoting sustainable development; empowering women; supporting countries in crisis or instability; generating new momentum on disarmament, arms control, and nonproliferation; and strengthening the UN. Among his many activities as secretary-general, he has successfully raised major pledges and financing packages for aid and crisis response, established the agency UN Women, and introduced new measures to promote UN transparency and efficiency.

Ban was born in the Republic of Korea in 1944, and he served for 37 years with the ROK Foreign Ministry, in roles including that of minister of foreign affairs and trade, foreign policy adviser to the president, and chief national security adviser to the president. He took office as UN secretary-general in January 2007, and was re-elected for a second term by the UN General Assembly in June 2011. Ban will serve as secretary-general until December 2016.

The Walter H. Shorenstein Asia-Pacific Research Center (Shorenstein APARC) and the Freeman Spogli Institute for International Studies are co-sponsoring the event. Ban's talk, part of the Asia-Pacific Leaders Forum, will kick off a series of activities commemorating Shorenstein APARC's thirtieth anniversary.

Founded in 2005, Shorenstein APARC's Asia-Pacific Leaders Forum regularly convenes senior leaders from across Asia and the Pacific to exchange ideas on current political, economic, and social dynamics in the region.

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Ban Ki-moon Secretary-General of the United Nations Speaker
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Asia-Pacific Leaders Forum

Remittances, Informal Loans, and Assets as Risk-Coping Mechanisms: Evidence from Agricultural Households in Rural Philippines

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This paper investigates whether agricultural households in the rural Philippines insure their consumption against income shocks and whether they use migration, remittances, informal loans, or assets as ex post risk-coping mechanisms. Since these households have limited access to formal insurance and credit markets, any shocks to their volatile income can have substantial impacts. Using panel data, and rainfall shocks as the instrumental variable for income shocks, this paper finds little evidence of effective risk-sharing within the networks of family and friends. 2SLS, OLS, and SUR estimates show that only about 16 percent of consumption is insured. While domestic remittances from other families replace about 51 percent of income decline, informal loans decrease by about 34 percent. Additional tests, however, reveal that agricultural households
engage in entrepreneurial activity when rainfall increases and children are somehow protected from the adverse effects of rainfall shocks. Hours spent on own family-operated businesses likewise increase.

Published:  Pajaron, Marjorie C. Remittances, informal loans, and assets as risk-coping mechanisms: evidence from agricultural households in rural Philippines. No. 2014-16. Discussion Paper, School of Economics, University of the Philippines, 2014.

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Asia Health Policy Program working paper # 32
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Health and Aging in Japan

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Professor Hidehiko Ichimura of the University of Tokyo will share recent results from his research on the health of older adults and the retirement process in Japan. His research draws upon a unique data source, the Japanese Study of Aging and Retirement (JSTAR). This rich dataset provides information on how middle-aged and elderly Japanese live in terms of economic, social, and health outcomes, and how these interact with their family status. The JSTAR project aims to provide longitudinal data enabling detailed policy-relevant comparisons to other industrialized countries (e.g. the Survey on Health, Aging and Retirement in Europe, the U.S. Health and Retirement Study, the English Longitudinal Study on Aging, and similar surveys now launched in Korea, China, and India).

Professor Ichimura received his BA in economics from Osaka University in 1981 and his PhD in economics for the Massachusetts Institute of Technology in 1988. He has taught at the University of Minnesota, the University of Pittsburgh, and University College London. He is currently a professor in the Graduate School of Public Policy and Graduate School of Economics at the University of Tokyo. 

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Hidehiko Ichimura Professor, Graduate School of Public Policy and Graduate School of Economics Speaker the University of Tokyo
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